Bottom Line:
Recannulation was attempted by using two alternative methods, namely a micro-catheter set via percutaneous access and a snare (rendezvous) technique using percutaneous and endoscopic approaches.Strictures were successfully cannulated in 16 (84%) of the 19 patients.A microcatheter set was used in 12 and a snare technique in four patients.

Affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT

Objective: To assess the clinical efficacy of alternative techniques for biliary stricture cannulation in patients undergoing living donor liver transplantation (LDLT), after cannulation failure with a conventional (0.035-inch guidewire) technique.

Subjects and methods: Of 293 patients with biliary strictures after LDLT, 19 (6%) patients, 11 men and 8 women of mean age 48.5 years, had the failed cannulation of the stricture by conventional techniques. Recannulation was attempted by using two alternative methods, namely a micro-catheter set via percutaneous access and a snare (rendezvous) technique using percutaneous and endoscopic approaches.

Results: Strictures were successfully cannulated in 16 (84%) of the 19 patients. A microcatheter set was used in 12 and a snare technique in four patients. Stricture cannulation failed in the remaining three patients, who finally underwent surgical revision.

Conclusion: Most technical failures using a conventional technique for biliary stricture cannulation after LDLT can be overcome by using a microcatheter set or a snare (rendezvous) technique.

Mentions:
Cholangiography before attempting alternative techniques revealed that the obstructions were complete (i.e., no passage of contrast medium through the stricture) in 15 patients and incomplete in the remaining 4. Strictures were successfully cannulated using the microcatheter set (Fig. 2) in 12 patients and the snare technique (Fig. 3) in 4. Cannulation failed in the remaining three patients, who thereafter underwent surgical revision. The technical failure rate was higher in patients who underwent Roux-en-Y hepaticojejunostomy (33%, 2/6) than duct-to-duct biliary reconstruction (8%, 1/13), but the difference was not statistically significant (p = 0.222, Fisher's exact test). There were no procedure-related complications. The median number of attempted conventional techniques prior to the use of an alternative technique was 4 (range, 1-23).

Mentions:
Cholangiography before attempting alternative techniques revealed that the obstructions were complete (i.e., no passage of contrast medium through the stricture) in 15 patients and incomplete in the remaining 4. Strictures were successfully cannulated using the microcatheter set (Fig. 2) in 12 patients and the snare technique (Fig. 3) in 4. Cannulation failed in the remaining three patients, who thereafter underwent surgical revision. The technical failure rate was higher in patients who underwent Roux-en-Y hepaticojejunostomy (33%, 2/6) than duct-to-duct biliary reconstruction (8%, 1/13), but the difference was not statistically significant (p = 0.222, Fisher's exact test). There were no procedure-related complications. The median number of attempted conventional techniques prior to the use of an alternative technique was 4 (range, 1-23).

Bottom Line:
Recannulation was attempted by using two alternative methods, namely a micro-catheter set via percutaneous access and a snare (rendezvous) technique using percutaneous and endoscopic approaches.Strictures were successfully cannulated in 16 (84%) of the 19 patients.A microcatheter set was used in 12 and a snare technique in four patients.

Affiliation:
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT

Objective: To assess the clinical efficacy of alternative techniques for biliary stricture cannulation in patients undergoing living donor liver transplantation (LDLT), after cannulation failure with a conventional (0.035-inch guidewire) technique.

Subjects and methods: Of 293 patients with biliary strictures after LDLT, 19 (6%) patients, 11 men and 8 women of mean age 48.5 years, had the failed cannulation of the stricture by conventional techniques. Recannulation was attempted by using two alternative methods, namely a micro-catheter set via percutaneous access and a snare (rendezvous) technique using percutaneous and endoscopic approaches.

Results: Strictures were successfully cannulated in 16 (84%) of the 19 patients. A microcatheter set was used in 12 and a snare technique in four patients. Stricture cannulation failed in the remaining three patients, who finally underwent surgical revision.

Conclusion: Most technical failures using a conventional technique for biliary stricture cannulation after LDLT can be overcome by using a microcatheter set or a snare (rendezvous) technique.